Background
Delirium is a serious condition associated with increased mortality and length of hospital stay. Older age is a key risk factor, and early screening and recognition of delirium risk are important to improve outcomes for patients.
Delirium often goes undetected in Victorian emergency departments (EDs) and urgent care centres (UCCs) due to multiple environmental and clinical demands on staff. There is a lack of consensus on best practice and significant variability in the screening and monitoring of delirium in these settings.
Improving the administration of a validated screening tool for delirium in ED and UCCs allows services to better understand the proportion of older people impacted by, or at risk for, delirium at arrival to the hospital. In doing so, appropriate care pathways can be activated to improve outcomes for patients.
Aim
The Delirium Evaluation in the Timely delivery of Emergency Care Trial (DETECT) pilot project aimed to better our understanding of the proportion of older people*, who are impacted by delirium in emergency care.
We strived to do this by improving the administration of a delirium screening tool in emergency care settings, with health services setting their own goal of how much to improve by the end of the testing phase (September 2024).
*≥65 years and older, with >45 years and older for First Nations people.
Improvement approach
SCV shared a pilot guide resource, provided 3 online learning sessions, and facilitated monthly action learning communities for participating health services, providing improvement coaching and opportunities for shared learning. Group meetings, emails and 1:1 discussion encouraged collaboration among health services and with SCV.
Results at a glance
Health services
14 Victorian health services encompassing 22 emergency care sites (both EDs and rural UCCs) participated through the implementation period.
Impact and duration
26,373 older Victorians were audited for delirium screening processes at participating sites, during the testing period May to September 2024.
Results
- Explorative baseline data collection showed before the testing phase, an aggregated average of 8% (<1 in 10) of older people were screened for delirium in participating sites using a completed tool, and 17.6% of these screened positive for suspected delirium.
- At the end of the testing period, screening increased on average to 33% (1 in 3) screened and 18% of these screened positive for suspected delirium on the completed tool.
- A significant increase in the diagnosis of delirium coded in EDs during the pilot period.
- Improving staff education about delirium in emergency care and embedding a simple and effective process were enablers for success.